Postoperative variation of C-reactive protein and procalcitonin in patients with gastrointestinal cancer

Despite substantial advances in radiotherapy, chemotherapy and immunotherapy, surgical management remains the standard of care, especially in patients with no evidence of distant metastases and who are fit for surgery. It is traditionally known, however, that patients undergoing surgery for gastrointestinal malignancies suffer from a high rate of infective complications and there is little information on the behavior of C-Reactive Protein (CRP) and procalcitonin (PCT) in these patients.

The study population included 18 consecutive patients with untreated gastric (n = 6) or colorectal (n = 12) carcinoma and 18 control subjects. Blood samples were collected from cancer patients the day before surgery and on the following 1, 7, 30 postoperative days. Results of PCT and CRP were corrected for plasma volume changes.

Pre-surgery values of CRP, but not of PCT, were significantly higher in cancer patients than in controls. Both markers in patients without postoperative infections reached peak-levels on day 1. On day seven, CRP values were still significantly increased, while those of PCT were non statistically different from pre-surgery. By receiver operating characteristic (ROC) analysis, both PCT and CRP discriminated patients with or without pneumonia on the day 7 post-surgery, but not between patients with or without surgical wound infection.

Taken together, our findings are consistent with the hypothesis that PCT might be a more useful marker than CRP for monitoring the postoperative course and diagnose severe perioperative bacterial infections in patients undergoing surgery for gastrointestinal malignancies after the 7th postoperative day.